Breaking the dependency cycle

How health inequalities of vulnerable families can be tackled in Western Europe

New Zealand like other countries has sub-populations with varying health outcomes and sometimes severe inequalities: These sub-populations are typically characterised by ethnicity and / or social deprivation – and they have varying degrees of access to health and other services. This results in significantly different health outcomes in terms of mortality or hospital admission rates. The latest report from Deloitte’s UK Centre for Health Solutions discusses how European countries are tackling these challenges and provides inspiring examples and case studies where impressive gains have been made in reducing such inequalities.

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Introduction

Vulnerable families face significant health inequalities, despite rising life expectancy across Western Europe. While access to good healthcare is important, it only accounts for 15-25% of health inequalities. A range of social determinants crucially drive trends around mortality and ill-health, including quality of education, housing, employment, working conditions and welfare.

These are among the findings of a new Deloitte Centre for Health Solutions report – Breaking the Dependency Cycle: Tackling Health Inequalities of Vulnerable Families – which warns of the damaging consequences of health inequality.

Our study reveals how health inequalities hold back all generations, from early childhood to old age. Offering a host of case studies, it recommends a life-cycle approach to vulnerable families – with governments and providers urged to break down organisational barriers and collectively face up to challenges.

Health inequality across the generations

Health inequalities have a substantial economic impact, hitting labour productivity and accounting for an estimated 20% of European healthcare costs. But they also take a social toll, with negative socioeconomic circumstances having a cumulative effect throughout a person’s life. Unemployment and financial disadvantages pass between generations, as vulnerable children become vulnerable adults.

Health inequality threatens people across all life stages, including:

Maternity and infancy
Infants require effective maternity care and well-educated mothers to maximise their chances of enjoying a healthy life. But wide gaps remain, and infants in lower socioeconomic groups have benefited less from falling mortality and morbidity rates.

Childhood and education
Children who engage with society, stay active and eat well are significantly more likely to become productive, socially-included adults. Yet children brought up in stressful environments have fewer opportunities to exercise and eat healthily, facing a greater risk of obesity, drug abuse, and emotional and behavioural problems.

Adulthood and employment
Working conditions, social opportunities and the built environment can influence people’s vulnerability to disease and death during adulthood. Workers in low-paid jobs are more exposed to health risks, while deprived environments with limited green space hinder healthy behaviours.

Elderhood
Older adults in lower socioeconomic groups are 30-65% likelier to face chronic disease, while they’re also at risk of depression, housing deprivation and weak digital engagement. Poverty, social isolation and ill health perpetuate each other.

Bridging the health gap: Key actions for stakeholders

A whole-system, whole-life approach is urgently needed to tackle health inequalities. Governments, providers, academics and businesses must integrate their services, working across institutional boundaries instead of in silos. We recommend that:

policymakers combine and align policies across people’s life-spans to reduce inequality, using a single-citizen identifier, and deliver adequate health and social care funding which includes new models of integrated funding

public service providers integrate health promotion and prevention across their workforce, and adopt a key-worker approach to help families

academics develop tools to boost health economics research and make effective use of population data – measuring the return on investment offered by interventions

Contacts

Partner – Strategy and Operations Consulting

I lead our Strategy & Operations practice and our social innovation and impact services in New Zealand. My focus areas are operating model change, transformation of social services and human centred d... More

Partner - Consulting

As leader for the Deloitte healthcare practice in New Zealand, I am deeply passionate about improving the health and well-being of New Zealanders. Since I carry qualifications in both medicine and in... More

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